(1) Vendor needs to provide third-party administrator workers compensation services.
A. Claims Administration:
- Review all claim reports for illnesses and injuries incurred or reported on or after the Effective Date of the resultant Contract and process each claim report in accordance with applicable statutory and administrative regulation requirements.
- Investigate each reported claim, including the use of medical or other experts, to the extent deemed necessary by the successful Proposer and with prior approval by the City in connection with processing any claim.
- Pay, on behalf of the City, medical and death benefits, temporary and permanent disability benefits, vocational rehabilitation expenses, and other expenses for claims, but only if, in the judgment of the successful Proposer, such payment would be prudent for the City.
- Pay all allocated claim expenses with City funds. Allocated claim expenses will include all expenses incurred in connection with the investigation, adjustment, settlement, or defense of claims.
- Independent medical examinations of claimants
- Managed care expenses.
- Fraud detection expenses, such as surveillance, and other related expenses associated with the detection, reporting and prosecution of fraudulent claims, including legal fees
- Attorneys, experts, and special process servers
- Court costs, fees, interest, and expenses
- Depositions, court reporters, and recorded statements
- Index bureau and Office of Foreign Assets Control charges
- Charges for medical records, personnel documents, and other documents necessary for adjudication of claims under the City's program
- Review all pending legislation, Nevada Administrative Code, and any case law that may affect the City's self-insurance program and advise the City of impact and options.
- Provide staff as required to administer the workers' compensation program in full compliance with all requirements in this Request for Proposal and the Contract with one dedicated adjuster assigned on-site at the City to handle non-maintenance claims and non-future medical claims.
- Maintain an electronic file for each claim, which shall be available for review safely and securely through an online platform by the City.
- Provide daily feed of information to and from their database with the City's Origami Risk program
- Assist legal counsel selected by the City with defending litigated cases, as requested by the City, including, but not limited to, attending depositions, testifying, and performing other tasks as may be required by law.
- Maintain a current estimate of the expected total cost of each claim. Reserve change rationales must be specifically documented in the adjuster's notes.
- Provide claim forms and other forms believed by successful Proposer to be appropriate for the efficient operation of the City's Self-Insurance Program and consistent with state statutes and administrative codes.
B. Medical Management
C. Administrative Compliance
D. Other Services as Requested by the City
(2) The contract period will be for three years.
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